LOS ANGELES -- State budget cuts to a breast cancer screening program for low-income women have forced some mammogram providers to shutter clinics and idle mobile units, leaving many eligible women and those formerly eligible without a place to turn.
The financially strapped California Department of Public Health temporarily banned new enrollments to the Every Women Counts program from January until July 1. But it also upped the age to qualify for the program from 40 to 50.
The changes are intended to reduce the number of mammogram recipients to 259,000 this fiscal year from last year's 311,000.
No women were screened by The Elizabeth Center for Cancer Detection in downtown Los Angeles in April, where 13,000 mammograms were performed last year. Patients who visited the clinic last month found signs in English and Spanish announcing a temporary closure. Clinic CEO Don Cook said it has become impossible to make ends meet.
Since 1944, Elizabeth Center has operated as a clinic that provides breast cancer diagnostic services, focusing on cancer detection and prevention for low-income women. About 86% of its patients are Hispanic.
In the first three months of 2010, the number of patients dropped 34%, from 3,354 to 2,202 patients. After going dark in April, the clinic is now offering services three days a week.
Cook says the clinic, without additional funding, is facing the possibility of permanent closure at the end of May.
"It's been a long haul, 65 years, to go down in a cloud of fire. It's a big disappointment," said Cook.
Cook said he asked Los Angeles County supervisors for financial help, to no avail, and that he intends to write President Barack Obama for help.
In the current health care system, Cook said, wellness and prevention are low priorities. "There's no money in prevention," he said. The money "is in treatment."
Al Lundeen, spokesman for the California Department of Public Health, declined repeated requests from The Associated Press for the number of mammograms the state has paid for under the program since the cuts were put into place Jan 1.
Lundeen said the number was not available because the billing cycle "won't be complete for six months."
But mammography clinics report their payments from the state are regularly received between four and six weeks after they are submitted, meaning some billing records should exist at the state level.
Nearly 4,000 women die of breast cancer in California every year. The Every Woman Counts program was established in 1991 to provide free mammograms and diagnostic services, such as ultrasounds and biopsies, for low-income women.
Women over 65 qualify for mammograms through Medicare. The change in age eligibility affects those younger than 65, and has significantly reduced the number who qualify for Every Woman Counts.
Though the shift in age eligibility closely mirrors controversial recommendations from a federal government panel, state officials said the change was planned long before the panel spoke.
California is the only state that has adjusted its mammogram rule based on age since the federal recommendation was issued, said Sean Tuffnell, a public policy expert for Susan G. Komen Foundation for the Cure, a Dallas-based breast cancer organization.
"We know that about 10% of all women who are diagnosed with breast cancer nationally are under the age of 45," said Tuffnell, adding that cancer that strikes younger women also tends to be more aggressive.
California lawmakers have made deep cuts to many programs over the past few years but still face a projected $20 billion shortfall through June 2011.
The program received a total of $61.3 million in funding for fiscal year 2009-10, almost $10 million more than the previous fiscal year. But officials said the increase in funding didn't match higher costs and reflected a one-time budget boost from an unspent past tax.
About $55 million of the funding came from tobacco taxes, which officials say are now declining, and the rest came from a Centers for Disease Control and Prevention grant.
A bill in the California Senate appropriations committee seeks to reinstate funding for the program. The bill's author, Sen. Jenny Oropeza, D-Long Beach, doesn't mince words: "We are sentencing women to death.
"Women will delay their mammogram screenings and as a result will have cancer detected at a later stage when it is harder to cure," she said.
Deborah Wright, president of Mobile Mammography Screening, laid off all of her 40 mammography technicians and idled her 11 mobile units. The mobile clinics averaged about 6,250 patients a month last year. In January only 1,600 patients were screened.
The tighter eligibility means that many locations can't organize enough women for screenings to cover costs for the Los Angeles-based mobile clinics.
"We require 20 patients to go out and since this program has been cut, we haven't been able to come up with the patients. It's been very severe," Wright said.
Rural screenings have been repeatedly canceled in remote and medically underserved areas like Calexico and El Centro, "so that basically no women received service in those areas," Wright said.
She believes one result will be a loss of trust among immigrant women, a population that the mobile clinics serve, often with additional funding from Avon or Komen for the Cure. "Some of these women are not legal, but they work with us and they're women we live with," Wright said. "This will certainly result in some early mortality."
About a year ago, Alesia Humphries, 44, panicked when she found blood coming from her breast.
Uninsured, the Newhall resident was able to quickly get a mammogram under Every Woman Counts at the Sheila R. Veloz Breast Imaging Center. After no cancer was found, Humphries was grateful for her clean bill of health, and she avidly spread the word about the service provided by Every Woman Counts.
"I called my mother, I called every woman I know and told them about it," she said.
But when Humphries tried to get a checkup this year, she called a long list of clinics, only to learn the age requirement has been upped to 50.
"I think, 'God, what if I have cancer," Humphries said.
She said she's still going to try to find a mammogram she can afford.
Nurse Carol Rascon coordinates care under Every Woman Counts at six clinics in Imperial County, a sun-beaten swath of rural communities along the Mexican border east of San Diego. Last year, the clinics provided mammograms to 4,185 women in the area, where many residents are immigrants and unemployment rates are high.
A small grant has made it possible for mobile units to visit Rascon's clinics every two months, but diagnostic services Every Woman Counts covered including surgical consultation, fine needle aspiration and biopsies are not available, said Rascon.
"Now we have to pull our hair and pray for the best and see what is out there," said Rascon, who tries to find affordable medical providers for her low-income patients, who also often face transportation hurdles.
"What happens to the women that you were concerned about?" Rascon asked. She hopes funding is restored. But, for now, the answer is, "I don't know."